Pharm Prac III Exam 1

chlorhexidine

(Peridex) Gingivitis, peridontitis 15 mL oral rinse, swish for 30 sec and spit bid after brushing Dental calculus, tooth staining, toothache, headache Wait several hrs after use before eating/drinking Don’t rinse with water right after use Discolored teeth can be removed after dental cleaning Do not use in broken skin, eyes, ears, mouth, nose, genitals, anal or swallow

Sodium fluoride tablets and drops

(Fluoritab, Flura-Drops) Dental caries (cavities) Dissolve in mouth or chew and swallow after brushing teeth at bedtime Dental fluorosis Dose depends on patient age and fluoride content of local water source

Do not take with dairy

Sodium Fluoride gel/cream/paste

(Prevident) Dental caries (cavities) Brush twice daily Dental fluorosis Dose depends on patient age and fluoride content of local water source Do not take with dairy

Rinse with water after use (depends on specific product)

Nitroglycerin sublingual tablets

(Nitrostat) Chest pain 1 tablet at sign of attack, repeat every 5 min if needed for max 3 tablets in 15 minutes HA, hypotension, flushing, dizziness Call 911 if more than one dose is needed (may be sign of serious condition, heart attack, etc)

Tretinoin

(Retin-A, Renova) Acne Apply thin layer topically to acne lesions once daily at bedtime Burning, dryness, erythema, exfoliation, peeling, photosensitivity (when starting) Avoid pregnancy Acne can get worse before it gets better

Can use moisturizer (dryness) and sunscreen (photosensitivity)

Clindamycin / Benzoyl peroxide (topical)

(Benzaclin) Acne Apply pea sized amt to affected area once daily Generally titrated but may cause: Dry skin, itching/burning, D (rare) Avoid excessive sunlight exposure (can cause photosensitivity)

Similar to benzoyl peroxide on its own (bleaching, etc)

Isotretinoin (oral)

(Accutane, Myorisan, Amnesteem ) Nodulocystic acne bid Xerostomia, alopecia, arthralgia, dry eyes/skin Avoid pregnancy: iPLEDGE Can cause depression or suicidal ideation in teenage populations

Azelaic acid (topical)

(Finacea, Azelex) Acne Apply thin layer to affected area twice daily Burning, pruritus, Photosensitivity  Hypopigmentation reported, medication is flammable, avoid contact with mucous membranes, can exacerbate asthma.

Mupirocin

(Bactroban) Impetigo Apply topical ointment to lesions tid for 3 to 5 days Burning sensation, application site pain, pruritus, stinging. Not recommended for use on IV cannula or central line sites due to fungal infection or antimicrobial resistance. Usually used before surgery or other procedures to avoid bacterial colonization

Buspirone

(Buspar) Anxiety (FDA label), Depression,  Shivering, Temperature management (off-label) 5mg p.o bid-tid or 7.5mg p.o bid may titrate to 20-30mg/D in 2-3 divided doses (60 mg/D) Dizziness, could cause some impairment but not as sedating as other anxiety meds Must use regularly (not PRN) to prevent anxiety Effects may not be seen for a few weeks  Take w or w/o food  Avoid activities requiring mental alertness or coordination Do not drink alcohol or large amounts of grapefruit juice while taking drug Do not discontinue drug suddenly, take drug consistently Avoid concurrent use w/ MAOIs

Methylphenidate

(Ritalin) ADHD, narcolepsy 20-30 mg between 30-45 minutes before meals once daily Can also do one in the morning and one in the afternoon ADR: increased blood pressure or heart rate, decreased appetite, nausea, headache Counsel: report serious cardiovascular effects, children may have decreased appetite, take during the day to avoid insomnia

Lisdexamfetamine

(Vyvanse)  ADHD Binge eating disorder 30 mg po QD in morning (NTE 70 mg/d) ADR: Insomnia, irritability, loss of appetite, upper abdominal pain, xerostomia Counseling: Take in morning with/without food Can open capsule and dissolve drug in water, yogurt, or OJ D/c if no improvement after 1 mo use Seek HCP if worse psychiatric problems, insomnia, changes in mood, chest pain

Dextroamphetamine

(Dexedrine) ADHD: Adult transdermal patch  9-18mg/9hrs NTE 1 patch/day; Children >3: 2.5-40mg po qd Narcolepsy: 5-60 mg po qd (or 2-3 divided doses) ADR: Decreased appetite, decreased neutrophils, site irritation, headache/dizz, upset stomach, insomnia, hypertension, xerostomia Counseling:  Oral: Take first thing in morning bc of insomnia, do not crush or chew ER/SR Patch:  renal dosing, NTE 9h applied time/24h, apply 2 h before effect is desired, avoid heat sources for abs, use immediately after opening

Dextroamphetamine / amphetamine

(Adderall) (amphetamine salts) ADHD: 20mg po daily Narcolepsy: 5-60mg/d po ADR: Hypertension, Weightloss, Loss of appetite, Xerostomia, Headache, Insomnia Counsel: Avoid taking at night due to insomnia. Can be taken with or without food. Capsules can be opened and sprinkled on soft foods. High abuse potential. May induce psychosis.

Modafinil

(Provigil)  Excessive somn (narcolepsy or obstructive sleep apnea) Max 400 mg once daily by mouth in the morning Nausea, headache, insomnia, anxiety. Caution use if patient has cardiovascular issues.  Watch for steven-johnsons-syndrome Discontinue if mania, delusions, hallucinations, suicidal ideation, or increased aggression has occurred. Caution use in patients with prior psychosis, depression, or mania as medication can exacerbate these. May decrease effectiveness of hormonal/IUD contraception

Fluconazole

(Diflucan)  Candidal vulvovaginitis (complicated/uncomplicated) Candidiasis (systemic), Cryptococcal meningitis, Oropharyngeal candidiasis  150mg, 800mg, or 1200mg q.d p.o or 1/wk ADR: Headache Counse: Take w/o food  Advise to not take with other medication as their is a high interaction rate with drug  Do not take any new medications w/o consulting an PCP If taking a weekly dose, take on same day at the same time each week

Ketoconazole (oral)

(Nizoral)  Fungal infections of the skin or scalp 200-400 mg PO QD for 6 months Burning sensation, pruritis, nausea, vomiting Not indicated for onychomycosis, cutaneous dermatophyte, or candida infections. Report symptoms of hepatotoxicity. Avoid alcohol.

Terbinafine (oral)

(Lamisil)  Onychomycosis (fungal nail infection). Sporotrichosis (fungal skin infection; rose gardener’s disease), Tinea 250 mg QD for 6 wks (fingernail) or 12 wks (toenail) Tinea 2-6 wk) 500 mg BID for 3-5 wks until all lesions resolved AEs: HA, GI issues, hepatotoxicity, altered taste/ smell, thrombotic microangiopathy (clots in capillaries) Counseling: Seek HCP before use if pt has hepatic disease/issues

Nystatin oral suspension

GI / Oral Candidiasis 400,000-1,000,000 units po tid-qid ADR: well tolerated, GI (N/V/constip/stom upset), rash/mouth irrit (rare) Counsel: Ok in preg/breastf, shake before use, poorly absorbed

Nystatin powder and cream

(Mycostatin) Candidiasis of skin (cutaneous and mucocutaneous infections)[fungal skin infection] 100,000 units/g bid-tid until healing is complete ADR:  Dry skin, skin irritation, rash Counseling: AAA of intact skin. Do not get into eyes, nose or mouth. Avoid occlusive dressing, tight fitting diapers, and plastic pants.

Ketoconazole cream

(Nizoral) Candidiasis of skin (fungal skin infections) Apply 2% cream once daily on affected area for 2 weeks ADR: burning sensation, pruritis, nausea, vomiting Counsel: Product is flammable so avoid open flames. May cause site irritation or burning

Colchicine

(Colcrys)  Gout (mainly), Familial Mediterranean fever, MI/stroke etc.  1.2mg p.o at first sign of flare up followed by 0.6mg 1h later, then 0.6mg p.o qd or bid until flare resolution (1.8mg/D) D/N, V (less common) Instruct PT on appropriate dosing strategy for gout flares  Avoid grapefruit and grapefruit juice

Allopurinol

(Zyloprim)  Gout Initial: 100 mg PO QD Maintenance: 200-300 mg PO QD for mild 400-600 mg PO QD for moderately severe Maculopapular eruption, rash, diarrhea, nausea. Report skin rash, avoid activities requiring mental alertness or coordination (can cause drowsiness), can induce acute gout attack, take after meals to reduce GI upset, increase fluid intake during therapy to prevent renal stones.

Alendronate

(Fosamax)  Osteoporosis prevention and fracture risk reduction, Paget disease Androgen deprivation (off-label) Ost prevent: 5 mg po QD or 35 mg/wk Fract risk: 10 mg po QD or 70 mg/wk Paget: 40 mg po QD (for 6 mo) Andr: 70 mg po/wk Fever, decreased serum calcium Swallow with large glass of plain water Remain upright and don’t eat, drink, or take other meds for 30 mins after use (to help body absorb drug) Adequate calcium and vitamin intake required for efficacy

Ethinyl estradiol / etonogestrel

(NuvaRing)  Contraception Off-Label: Heavy Menstruation, Dysmenorrhea (endometriosis), Menstrual suppression 1 ring vaginally q 3 weeks, hold for 1 week ADR: Menstrual changes, Vaginities, HA, N/V, Acne, weight gain Counsel: -may interfere with other contraceptives like barriers -insert 1st day of menstrual cycle (or days 2-5) -Use barrier method for first 7 days

Oral ethinyl estradiol / drosperinone

(many)  Contraception 1 active tablet PO QD at the same time of day for 24 days followed by 1 inactive tablet daily for 4 days Acne, weight gain, nausea, headache, irregular intermenstrual bleeding. Take a tablet at the same time every day. If active dose is missed including vomiting or diarrhea within 3-4 hours after dose, take asap and then resume normal schedule.

Oral ethinyl estradiol / levonorgestrel

(many) contraception Depends on brand but usually one tablet po qd for 28 days (follow instructions according to package) Counsel: could be an increased risk for MI, stroke, or breast or endometrial cancer with long term use. Take at the same time each day.

Estradiol oral / topical

(Estrace) Menopause, Atrophic vulva, decreased estrogen level 1-2mg po daily  Pretty tolerable, Less common: Weight change, N/V, Mood changes  Report abnormal vaginal bleeding or s/s of thromboembolic disorder  Do not smoke during therapy → increase thromboembolic event  Vision changes or disturbances, migraine, or double vision

Medroxyprogesterone

(Provera)  Abnormal uterine bleeding, contraception, endometriosis Inject 150 mg IM once every 3 months Inject 104 mg SUBQ once every 12-14 weeks Injection site irritation, weight gain, abdominal pain, headache, feeling nervous, amenorrhea. Report symptoms of thromboembolic disorders or fluid retention or severe abdominal pain or mood disorders including worsening depression.

Progesterone

(Prometrium)  Estrogen-induced endometrial hyperplasia,  amenorrhea, assisted reproduction Off label: abnormal uterine bleeding, preventing pre-term birth Endo: 200 mg po QD HS (for 12d per 28d cycle) Ameno: 200-400 mg po QF HS (for 10d); 45 mg (4% gel) vaginally QOD (NTE 6 doses) Repro: 90 mg (8% gel) vaginally QD (and 10-12 wks after conception) Weight change, HA, amenorrhea, breast tenderness If using for amenorrhea, menstrual bleeding occurs 3-7 d after last oral dose (report to HCP if this does not happen) Avoid other vaginal drugs 6 hrs before/after use if vaginal insert used

Triamcinolone (topical)

(Kenalog)  Corticosteroid-responsive dermatoses  Qd, bid  Apply sparingly, may cause irritation, burning, use for designated period of time (usually no more than 2 weeks), skin atrophy may occur with overuse

Betamethasone

(Diprolene, Valisone)  Corticosteroid-responsive dermatoses Dermatosis, corticosteroid response Plaque psoriasis  Bid, qid ;Diprolene: 1/day, Valisone: 1-3/day ADRs: Burning/Stinging, Itching, Dry skin,  Counseling: Use as directed, do not stop until the course is complete. TOPICAL use only. Do not use covering or bandages unless told. Wash hands after use. Clean and dry affected area before use. DO NOT use it on face/groin/underarms unless told to do so.

Fluocinonide

(Lidex) Corticosteroid-responsive dermatoses  Atopic dermatitis Bid, qid  Burning sensation, headache Avoid occlusive dressings, cosmetics, or other skin care products on affected area. Avoid use of other corticosteroids. Report symptoms of adrenal suppression.

Clobetasol

(Temovate)  Corticosteroid-responsive dermatoses  bid , apply thin kayer topically for MAX 2wks   Pruritus at the site of administration, Less common: Burning, stinging, HA Wash hands after administration Avoid contact with eyes or mouth  Avoid occlusive dressings or tight-fitting clothes over site of administration

Mometasone

(Elocon)  Corticosteroid-responsive dermatoses  qd

Alprazolam Exam 2

(Xanax) Anxiety, panic attacks, acute vertigo episodes IR: start 0.25 mg po 3-4x/d (NTE 10 mg/d) ER: start 0.5-1 mg/d (NTE 10 mg/d) May inc in 1mg/d increments (for IR and ER) Vertigo: 0.5 mg po q8h PRN (NTE 2-3d) Dry mouth, changes in hunger (major increase or decrease), sexual dysfunction Avoid alert activities before AEs fully known Use as directed by HCP to avoid abuse/addiction risks Breakthrough anxiety possible at end of dosing interval (sudden, brief anxiety episode)

Clonazepam Exam 2

(Klonopin) Seizure Off-label: Tardive dyskinesia, Anxiety, Rapid eye movement in sleep Children <10/<30kg 0.01- 0.03mg/kg/d po 2-3 divided doses Adults 2-8mg po in 1-2 divided doses AE: Ataxia, lethary, somnolence, weight gain, tachycardia/palpitations, N/V Counsel: watch for rare seizures, avoid driving etc (drowsiness), avoid alcohol, allow ODT to dissolve on tongue, abuse potential

Diazepam Exam 2

(Valium) Substance abuse withdrawal syndrome, Anxiety, Seizure, adjunct, Muscle spasm or rigidity 2-10mg po bid-qid;  NTE 40mg/d ADR: Drowsiness, impaired motor coordination, confusion, blurred vision, nausea and vomiting Counseling: Can cause thoughts of suicide. May cause drowsiness so avoid anything that requires fine motor control. Avoid alcohol use. Can also cause ataxia, the loss of muscle control. Careful with CNS depressants.

Lorazepam Exam 2

(Ativan)  Anxiety 3 tablets by mouth daily divided evenly during the day Dizziness, sedation, depression Do not stop medication suddenly as it can cause withdrawal symptoms. Avoid activities requiring mental alertness or coordination until effects are realized. Avoid pregnancy and alcohol or other CNS depressants.

Eszopiclone Exam 2

(Lunesta) Insomnia 1mg po immediately before bedtime PRN, may be titrated to 2-3mg, MAX: 3mg/d  HA, taste disorder, Less common: confusion, D/N/V, rash , confusion

Zolpidem Exam 2

(Ambien)

Trazodone Exam 2

(Desyrel) MDD, Insomnia,  agitation in dementia MDD: 100 mg po QD (may titrate to 400 mg/d) Insom: 50-100 mg po QD HS Agitation: 25-50 mg po QD HS Dizziness, sedation, HA, nausea, xerostomia Avoid driving or alert activities until AEs fully known Avoid MAOIs within 14d of use; alcohol, barbiturates, CNS depressants during use Do not stop use abruptly

Epinephrine Inj Exam 2

(Epi-Pen, Auvi-Q) Anaphylaxis Children: 0.1-0.15mg IM/SQ once Adults 0.3mg IM/SQ once, may repeat if severe anaphylaxis persists AE: Anxiety, Palpitations, Restlessness/Tremor, N, asthenia Counsel: potential pregnancy risk, See medical attention after use, inject into thigh

Oxybutynin Exam 2

(Ditropan) Overactive or neurogenic bladder IR: 5mg bid-tid; NTE 5mg po qid ER: 5-10mg po d; NTE 30mg po d Patch: 1 patch twice weekly ADR: Constipation, xerostomia, blurred vision, nausea, GI issues Counseling: May cause anticholinergic effects, including constipation, urinary retention, blurred vision, dyspepsia or xerostomia. Decreased sweating. Heat prostration can occur when used in hot environments.

Tolterodine Exam 2

(Detrol) Overactive bladder Qd or bid depending on if IR or ER IR: 2 mg po bid, ER: 4 mg po qd Xerostomia, constipation, headache Avoid activities requiring mental alertness or coordination until effects are realized. May cause blurred vision, dizziness, and drowsiness.

Mirabegron Exam 2

(Myrbetriq) Overactive Bladder 25-50mg po daily  HTN, Less Common: Ab pain, back pain, constipation, tachycardia  May take w/o food Tablet should not be crush, chewed, or divided  Monitor BP and HR

Tamsulosin Exam 2

(Flomax) BPH O/L: Neurogenic bladder, Bladder outlet obstruction, Ureteral stones 0.4mg po qd (can titrate up to 0.8mg) AE: Dizziness/Vertigo, HA, Rhinitis, Abnormal ejaculation, Orthostatic Hypotension/Edema/Asthenia Counsel: watch for Hypotension, take 30 minutes after same meal daily (for bioavailability), avoid driving/coordination heavy activities, Syncope may occur with first dose or dose increase

Doxazosin Exam 2

(Cardura)  BPH, HTN,, Expulsion of distal ureteral stone IR: 1 mg po QD ER: 4 mg po QD Dizziness, fatigue, malaise, vertigo Take initial dose with breakfast Avoid coordination activities until AEs fully known Rise slowly from sitting/lying to avoid orthostatic hypotension effects

Finasteride Exam 2

(Proscar) BPH, Male pattern baldness O/L: Hirsutism 1-5mg po qd AE: Impotence + reduced libido, Gynecomastia, dizziness, heart failure, angioedema Counsel: NO pregnancesy, may take 3 months for effect on hair loss, may take 6 months for effect on BPH,